Need Assistance?  Call  1-888-404-3549

Quality Assurance and Monitoring Programs

National Committee for Quality Assurance

NCQA AccreditationThe National Committee for Quality Assurance (NCQA) has awarded MedStar Family Choice accreditation status of "Commendable" for service and clinical quality that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement.

NCQA is committed to providing health care quality information through the web and the media in order to help consumers, employers and others make more informed health care choices. Learn more about NCQA at www.ncqa.org.

Quality Monitoring Programs

The Quality Improvement Department works closely with the Maryland Department of Health to ensure our members receive optimum care.

MedStar Family Choice currently participates in the following Quality Monitoring Programs:

  1. Healthcare Effectiveness Data & Information Set (HEDIS®*) — HEDIS®* is developed and maintained by the National Committee for Quality Assurance (NCQA), a not-for-profit organization committed to assessing, reporting on and improving the quality of care provided by organized delivery systems. HEDIS®* has become more than a set of measures; it is part of an integrated system to establish accountability in health care. HEDIS®* evaluates measures in the areas of preventive care (adults and children), immunizations of children and teens, care of pregnant women, and the care of chronic diseases like asthma and diabetes. The results are audited and reported to NCQA.
    *HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
  2. Satisfaction Surveys — The Maryland Department of Health  contracts with independent organizations to perform both member and provider satisfaction surveys for each Managed Care Organization.
  3. Systems Review Audit — To ensure that the services provided to our members meet established regulations, the Maryland Department of Health contracts with the Delmarva Foundation for Medical Care Inc (Delmarva) as an outside quality review agency to perform a Systems Performance Review. The purpose of the Systems Performance Review is to provide an annual assessment of the structure, process, and outcome of each Managed Care Organization's internal quality improvement program. Delmarva visits each Managed Care Organization every year to review the following standards: Quality Improvement, Accountability to the Governing Body, Oversight of Delegated Entities, Credentialing and Recredentialing, Enrollee Rights, Availability and Accessibility, Utilization Review, Continuity of Care, Health Education, Outreach, Fraud and Abuse.
  4. To ensure that the services provided to MedStar Family Choice pediatric members meet established regulations, preventive services for children are monitored by the Maryland Department of Health annually. The Quality Improvement Department works with providers to ensure that all providers seeing children are EPSDT certified and that they perform the services required under this program.
  5. Quality Improvement Plan Summary — The Quality Improvement staff for MedStar Family Choice performs ongoing reviews of any issues that arise between our providers and members to ensure that our members are receiving optimum care. The QI staff reports their findings to the Quality of Care Peer Review Committee. The committee performs peer review of all quality issues related to clinical care provided by a MedStar Family Choice credentialed provider.
  6. Consumer Report Card — The Maryland Department of Health uses many of the results from the monitoring activities listed above to develop a report card that shows the quality scores for all of the Managed Care Organizations. New enrollees receive this in their enrollment packet from the Maryland Department of Health. Current enrollees also receive this information when it is time to re-enroll.
Information current as of: 07/25/17